Concierge hand surgery · United Kingdom
Hand surgery for Dupuytren’s disease, every UK option honestly compared.
Needle release, fasciectomy, dermofasciectomy, or early-stage radiotherapy — set out against your MCP and PIP contracture, your diathesis, and the outcome that matters to you. By a BSSH hand surgeon, with a hand therapist built into the pathway.
Why patients choose us
- 01
A BSSH hand surgeon, not a general list
Dupuytren’s is fascia, nerves and skin in millimetres. We route you to a British Society for Surgery of the Hand consultant who does this weekly, not occasionally.
- 02
Every option on the table
Needle release, fasciectomy, dermofasciectomy, or early-stage radiotherapy — we set them out honestly against your contracture, joint, and prior surgery.
- 03
Hand therapy built in from day one
The single biggest predictor of a good outcome. We only work with surgeons whose patients see a CHT or POGP-registered hand therapist within the first week.
Indicative pricing
What private Dupuytren’s treatment costs in the UK.
Indicative UK ranges across our partner hand surgeons and radiotherapy centres. Send the details and we quote firm figures across two or three options.
In short
A limited fasciectomy in our UK network: £3,000–£6,000, day case, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Consultation with BSSH hand surgeon | £250–£450 | 30–45 min | Same visit |
| Needle aponeurotomy (PNF), per hand | £900–£1,800 | 20–30 min LA | Same day |
| Limited fasciectomy, single ray | £3,000–£4,500 | 60–90 min | Day case |
| Limited fasciectomy, multiple rays | £4,000–£6,000 | 90–120 min | Day case |
| Dermofasciectomy + full-thickness graft | £4,500–£7,500 | 120 min | Day case |
| Radiotherapy course (early disease) | £2,000–£3,000 | 10 fractions | 2 weeks |
| Hand therapy package (post-op) | £400–£900 | 4–8 sessions | 3 months |
Prices vary by centre, by the surgeon, by whether one ray or several are treated, and by whether a skin graft is needed. Hand therapy is quoted separately but is essential. We come back with a firm quote within one working day.
The problem
A benign disease with a lot of bad routes through it.
Dupuytren’s is a benign fibromatosis of the palmar and digital fascia — nodule to cord to a bent finger you cannot straighten. The treatments are not equivalent, and neither is the surgeon: the choice matters more than most patients are told.
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Not sure it needs treating yet?
A nodule with a straight finger and a negative Hueston test is watch-and-wait. Early cord may be a candidate for radiotherapy, not surgery.
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MCP versus PIP disease?
MCP contracture corrects well with almost any technique. PIP disease is harder to reverse and recurs sooner — timing and technique matter more.
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Which technique fits you?
Needle, fasciectomy, dermofasciectomy, radiotherapy — we say which one, on your hand, with your diathesis, and why.
The journey
From enquiry to hand therapy — what happens, in order.
One BSSH hand surgeon and one hand therapist from first message to full recovery.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the clinic
Phase 3 · After
Hand therapy and splinting
- 01
Before
You tell us what your hand is doing
A short, confidential form. Which hand, which fingers, how long, whether you can lay it flat on a table (Hueston test).
- 02
Before
We come back with a recommendation
Within one working day: whether it is nodule watch-and-wait, needle release, fasciectomy, dermofasciectomy or early-stage radiotherapy — and why.
- 03
Before
We arrange the consultation
Usually within one to two weeks with a BSSH hand surgeon. MCP and PIP contractures are measured, diathesis assessed, options confirmed.
- 04
On the day
Treatment day at the clinic
Needle release is minutes under LA. Fasciectomy is 60–90 minutes under regional block or GA in a proper theatre.
- 05
On the day
The procedure itself
Cord divided (needle) or dissected and removed (fasciectomy). Skin closed, or left open (McCash), or grafted (dermofasciectomy).
- 06
On the day
Home the same day
A bulky dressing, sling, and written aftercare. Someone to collect you after regional block or GA.
- 07
After
Hand therapy and splinting
First hand therapy appointment inside a week. Night extension splint for 3–6 months. Scar massage, oedema control, staged return to work.
Typical end-to-end: 2–3 weeks from enquiry to procedure. Hand therapy and night splinting: 3–6 months.
When it helps
When Dupuytren’s crosses the treatment threshold.
The situations we see most, plus the one red flag that needs an urgent hand surgeon opinion rather than a routine wait.
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Nodule in the palm
A firm lump near the ring or little finger base. Not painful, usually. Watch-and-wait — no surgery yet.
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Palpable cord, finger still straight
A rope-like thickening running into the finger. Radiotherapy may stabilise it before contracture forms.
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Positive Hueston tabletop test
You cannot lay your palm flat on a table. The UK referral threshold for treatment consideration.
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MCP contracture ≥ 20–30°
The knuckle joint is bent. MCP disease responds well to both needle release and fasciectomy.
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Any PIP contracture
The middle finger joint. Harder to correct, prone to recurrence — earlier surgical intervention is usually advised.
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Recurrent disease after prior surgery
Contracture back after previous fasciectomy or needle release — dermofasciectomy or salvage options are considered.
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Dupuytren’s diathesis
Ledderhose (foot), Peyronie’s (penile), Garrod’s knuckle pads, family history, onset before 50 — aggressive disease, worse prognosis.
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Red flag: skin breakdown or numb finger
Skin ulcerating over the cord, or a finger going numb or dusky — this needs an urgent hand surgeon opinion, not a routine wait.
Procedure options
The full UK treatment spectrum, honestly compared.
What each option actually involves, when it fits, and where its limits are. Read the dedicated pages for the technical detail on fasciectomy, needle release and early-stage radiotherapy.
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Needle aponeurotomy (PNF)
Outpatient, LA, needle divides the cord blindly. Best for a palpable MCP cord in an older or frail patient. Quick return; recurrence around 50% at 3 years.
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Limited fasciectomy
The UK mainstay. Bruner or longitudinal incision, diseased cord dissected and removed. Regional block or GA, 60–90 minutes, day case. Durable results.
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Dermofasciectomy + skin graft
For recurrent, severe, or skin-adherent disease. The overlying skin is replaced with a full-thickness graft (often from the arm). Lowest 10-year recurrence.
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McCash open-palm technique
Palm wound left to heal by secondary intention. Less bleeding and haematoma, longer wound care — useful in extensive palmar disease.
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Radiotherapy (early, non-contracted)
Kelly-protocol 30 Gy in 10 fractions over 2 weeks. For nodule and cord before fixed contracture. NICE IPG366-noted, stabilises 60–80%.
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Collagenase (Xiapex) injection
Enzyme dissolves the cord. NHS access withdrawn UK-wide in 2020 (Sobi discontinued European supply). A handful of private centres may still source it.
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PIP joint release, arthrodesis
For severe fixed PIP contracture: capsulectomy and volar plate release at operation, or fusion in the worst destructive cases.
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Amputation (last resort)
For advanced, recurrent disease with skin necrosis, neurovascular compromise, or a functionally useless flexed finger — considered only when reconstruction cannot work.
Our vetted UK network
A small panel of BSSH hand surgeons, we picked them.
Consultant hand surgeons across London, the South East, Midlands and North — many with dual NHS and private practice. Introductions are made privately once we understand your case.
Selection criteria
How we choose every hand surgeon in our network.
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BSSH-registered consultant hand surgeons, doing Dupuytren’s weekly
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Access to needle release, fasciectomy, dermofasciectomy and radiotherapy in one referral
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Post-operative hand therapy with a CHT or POGP-registered therapist inside the first week
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Realistic recurrence and outcome data given up-front for MCP and PIP disease
Safety and recovery
Realistic risks and recovery — technique by technique.
Dupuytren’s surgery is safe in good hands. The things worth planning are your technique choice, your hand therapy, and your honest recurrence expectation.
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Digital nerve and artery injury
The nerve and artery run alongside the cord. Risk is roughly 1–5% in fasciectomy, lower for MCP needle release, higher for PIP needle release where the anatomy is tightest.
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Skin necrosis and wound problems
More common after fasciectomy for recurrent disease and in smokers or diabetics. McCash or dermofasciectomy is sometimes chosen for exactly this reason.
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Complex regional pain syndrome (CRPS)
A painful, stiff, swollen hand affecting roughly 5–10%. Early hand therapy, oedema control and pain management reduce risk.
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Stiffness and flare reaction
A stiff, hot, swollen hand for a few weeks is common. Splinting and therapy work it out; ignoring it costs you range of movement.
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Recurrence is expected — how much varies
Needle release: 40–60% at 3–5 years. Fasciectomy: durable at 5–10 years, MCP >90% correction, PIP 60–80%. Dermofasciectomy: lowest recurrence at 10 years.
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Hand therapy is not optional
Single biggest factor in a good outcome. Night extension splint 3–6 months, scar massage, oedema management, staged loading.
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Diathesis worsens the outlook
Ledderhose, Peyronie’s, Garrod’s pads, early onset and family history all predict earlier and more aggressive recurrence — worth knowing before choosing an option.
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Time off work
Needle release: back to a desk in days. Fasciectomy: 2–4 weeks for office work, 6–8 weeks for manual work. Dermofasciectomy: longer, graft-dependent.
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Red flags after surgery
Numb or dusky finger, spreading redness, fever, or the dressing soaked through — call the clinic or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used — needle, fasciectomy, dermofasciectomy — the note the hand surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your hand therapy review, just ask.
- 01 Header
Which finger, which joint, which method
The ray treated (ring, little, middle), the joints released (MCP, PIP), and which technique was used (needle, fasciectomy, dermofasciectomy).
- 02 Technique
Anaesthetic, incision, extension achieved
Regional block or GA, incision pattern (Bruner, longitudinal, McCash open palm), and the on-table correction in degrees at MCP and PIP.
- 03 Findings
Cord anatomy, nerve, skin quality
Notes on the pretendinous and spiral cord, whether the digital nerve was displaced by the spiral cord, and any skin loss requiring graft.
- 04 Impression
Splinting, therapy, expected recurrence
Read this first: night splint schedule, hand therapy plan, when to drive, when to work, and the surgeon’s honest recurrence estimate.
Recognised by major UK insurers
Cover for Dupuytren’s surgery is usually funded when there is functional contracture (positive Hueston test, MCP ≥ 20–30° or any PIP contracture). We confirm cover before booking.
Frequently asked
Everything we get asked about Dupuytren’s treatment.
Quick answers on when to treat, needle vs fasciectomy, radiotherapy, cost, recurrence and time off work.
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When does Dupuytren’s actually need surgery?
UK practice, in line with NICE and BSSH: when you cannot lay your hand flat on a table (positive Hueston tabletop test), or there is around 20–30° of MCP contracture, or ANY PIP contracture — because PIP disease is harder to reverse the longer you leave it — or the hand is stopping you doing something that matters to you.
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Needle release or fasciectomy — which is better?
Neither is universally better. Needle aponeurotomy is quick, done under LA, and you are back to normal in days — but recurrence is 40–60% at three to five years. Limited fasciectomy is a proper operation with a longer recovery and more risk, but the correction is durable at 5–10 years. MCP disease and older patients often favour needle; younger patients, PIP disease and aggressive diathesis usually favour fasciectomy.
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Is collagenase (Xiapex/Xiaflex) still available in the UK?
For practical purposes, no. Sobi withdrew the European supply of collagenase clostridium histolyticum in 2020, so the NHS route closed. A very small number of private centres occasionally source it, but it is not a routine option in UK Dupuytren’s care in 2026.
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What is radiotherapy for Dupuytren’s and does it work?
Low-dose radiotherapy — typically 30 Gy in 10 fractions over two weeks (the Kelly protocol) — for early, non-contracted disease: nodule and cord before the finger has bent. NICE reviewed it under IPG366. Around 60–80% of patients see the disease stabilise. It does not straighten a finger that is already fixed.
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How much does private Dupuytren’s surgery cost in the UK?
Roughly £900–£1,800 for needle release, £3,000–£4,500 for a single-ray fasciectomy, £4,000–£6,000 for multi-ray fasciectomy, £4,500–£7,500 for dermofasciectomy with a full-thickness graft, and £2,000–£3,000 for a radiotherapy course. Hand therapy adds £400–£900. We confirm firm figures within a working day.
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What is a Dupuytren’s diathesis and why does it matter?
A cluster of features — Ledderhose (foot fibromatosis), Peyronie’s (penile fibromatosis), Garrod’s knuckle pads, a strong family history, northern European ethnicity, and onset before 50 — that together predict aggressive, early-recurring disease. If you have diathesis, dermofasciectomy is more likely to be recommended over needle release.
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How long is recovery and time off work?
Needle release: back to a desk in a few days, manual work in one to two weeks. Limited fasciectomy: office work in two to four weeks, manual or heavy work in six to eight. Dermofasciectomy: longer, dictated by graft healing. Night extension splinting continues for three to six months in every case.
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Will the disease come back?
Usually, at some point. Needle release recurs in 40–60% at three to five years. Fasciectomy holds well at 5–10 years, with MCP correction over 90% and PIP correction of 60–80%. Dermofasciectomy has the lowest 10-year recurrence rate. Diathesis shortens all of these timelines.
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When should I see a GP or urgent care?
A finger going numb or dusky, skin breaking down over a cord, spreading redness or a fever after surgery, or a dressing soaked through with blood — these are same-day problems, not routine follow-up.
Related tests and procedures
Looking for something else?
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Dupuytren’s fasciectomy
The open surgical operation in detail — technique, recovery, outcomes.
Learn more -
Needle fasciotomy (PNF)
Percutaneous needle release under LA — quick return, higher recurrence.
Learn more -
Radiotherapy for early Dupuytren’s
Low-dose radiotherapy for nodule and cord before contracture.
Learn more -
Hand therapy
CHT and POGP-led rehabilitation — the outcome-defining step.
Learn more